Provider Demographics
NPI:1386759652
Name:SATTERFIELD-SIEGEL, JENNIFER LOUISE (DDS PEDIATRIC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:SATTERFIELD-SIEGEL
Suffix:
Gender:F
Credentials:DDS PEDIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 N MICHIGAN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8170
Mailing Address - Country:US
Mailing Address - Phone:317-873-3448
Mailing Address - Fax:317-873-3425
Practice Address - Street 1:10801 N MICHIGAN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8170
Practice Address - Country:US
Practice Address - Phone:317-873-3448
Practice Address - Fax:317-873-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120094921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100464540Medicaid
IN352071116OtherTAX ID
IN100464540Medicaid